Transcatheter Aortic Valve Replacement for Failed Small Surgical Bioprostheses

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Limited data exists on the prognostic impact of small surgical bioprosthetic size in valve-in-valve transcatheter aortic valve replacement (ViV TAVR).
• Prosthesis-patient mismatch (PPM) is a potential complication following ViV TAVR, particularly with smaller bioprostheses.

Purpose of the Study:

• To evaluate the impact of small bioprosthetic size and subsequent PPM on midterm outcomes after ViV TAVR.
• To identify factors associated with severe PPM in patients undergoing ViV TAVR.

Main Methods:

• Analysis of 367 patients undergoing ViV TAVR from the OCEAN-TAVI registry.
• Patients categorized into small bioprosthesis (ID ≤20 mm) and non-small bioprosthesis (ID >20 mm) groups.
• Primary endpoint: composite of cardiovascular death or heart failure hospitalization at 3 years.

Main Results:

• Severe PPM was more prevalent in the small bioprosthesis group (21.3% vs 8.3%).
• The small bioprosthesis group exhibited a higher risk of cardiovascular death or heart failure hospitalization at 3 years (19.1% vs 9.8%).
• Small bioprosthesis patients with severe PPM had the highest risk of the primary outcome (39.2%).

Conclusions:

• ViV TAVR for small surgical bioprostheses is associated with worse clinical outcomes.
• Severe PPM significantly exacerbates the adverse outcomes in patients with small bioprostheses undergoing ViV TAVR.
• Factors contributing to severe PPM include larger body surface area, balloon-expandable valve use, and small bioprosthesis ID.